Provider Demographics
NPI:1558950824
Name:JACKSON, LINDSAY M (MA)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:M
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1437 E EVERGREEN DR APT 302
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074-8729
Mailing Address - Country:US
Mailing Address - Phone:773-766-7852
Mailing Address - Fax:
Practice Address - Street 1:1580 N NORTHWEST HWY STE 210
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1468
Practice Address - Country:US
Practice Address - Phone:331-240-0044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health